Objective To develop an objective and precise prognostic model for assessing severity and prognosis in elderly patients with community-acquired pneumonia(CAP)admitted to the emergency department.Methods A retrospective analysis was conducted on elderly patients with CAP admitted to Department of Emergency,Minhang Hospital,Fudan University between Jun 2018 and Dec 2020.With the primary outcome being the 30-day in-hospital mortality rate of elderly CAP patients,four systemic inflammatory response markers,including the neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SII)were evaluated using univariate and multivariate Logistic regression analyses.The predictive performance of different scoring systems was compared.Results A total of 421 elderly CAP cases were enrolled.The results of the multivariate Logistic regression analysis demonstrated that NLR was an independent risk factor for elderly inpatients with CAP.We combined NLR with the existing CURB-65 score for joint optimization to construct a scoring system or a clinical prognosis model,by quantifying and assigning optimal cut-off value of 11.4 for NLR,and established the NLR+CURB-65 score.The ROC curve was constructed to compare the areas under the curve of the three different scoring systems(NLR,CURB-65,and NLR+CURB-65).The area under the curve of the NLR+CURB-65 score was significantly higher than that of the CURB-65 score.Based on the optimal cut-off value of 3 for NLR+CURB-65 score,the patients were stratified into high-risk group(n=188)and low-risk group(n=233).The K-M survival curve was utilized and indicated that compared with high-risk group,low-risk group had a lower mortality rate and a higher discharge rate.Conclusion For elderly emergency hospitalized patients with CAP,the combination of NLR and CURB-65 score showed high predictive value for assessing disease severity and prognosis.

Objective To develop an objective and precise prognostic model for assessing severity and prognosis in elderly patients with community-acquired pneumonia(CAP)admitted to the emergency department.Methods A retrospective analysis was conducted on elderly patients with CAP admitted to Department of Emergency,Minhang Hospital,Fudan University between Jun 2018 and Dec 2020.With the primary outcome being the 30-day in-hospital mortality rate of elderly CAP patients,four systemic inflammatory response markers,including the neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SII)were evaluated using univariate and multivariate Logistic regression analyses.The predictive performance of different scoring systems was compared.Results A total of 421 elderly CAP cases were enrolled.The results of the multivariate Logistic regression analysis demonstrated that NLR was an independent risk factor for elderly inpatients with CAP.We combined NLR with the existing CURB-65 score for joint optimization to construct a scoring system or a clinical prognosis model,by quantifying and assigning optimal cut-off value of 11.4 for NLR,and established the NLR+CURB-65 score.The ROC curve was constructed to compare the areas under the curve of the three different scoring systems(NLR,CURB-65,and NLR+CURB-65).The area under the curve of the NLR+CURB-65 score was significantly higher than that of the CURB-65 score.Based on the optimal cut-off value of 3 for NLR+CURB-65 score,the patients were stratified into high-risk group(n=188)and low-risk group(n=233).The K-M survival curve was utilized and indicated that compared with high-risk group,low-risk group had a lower mortality rate and a higher discharge rate.Conclusion For elderly emergency hospitalized patients with CAP,the combination of NLR and CURB-65 score showed high predictive value for assessing disease severity and prognosis.

Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

In the context of China's aging population, the issue of urinary incontinence among the elderly is becoming increasingly severe.Urinary incontinence not only significantly impacts patients' quality of life, but also imposes a substantial economic burden and psychological stress.This article explores the challenges and prospects of the early intervention of elderly urinary incontinence in China, including improving early diagnosis rates, enhancing patients' self-management abilities, and early screening and prevention for high-risk groups.With the advancement of technology and medical innovations, digital self-management tools offer new possibilities for managing urinary incontinence, helping patients to better control their condition, especially when medical resources are limited.Furthermore, this article calls for greater attention from all sectors of the society to address elderly urinary incontinence and promote the implementation of more systematic research and management strategies to improve the quality of life for China's elderly population.

Based on the high-fat diet-induced hyperlipidemia rat model, this study aimed to evaluate the lipid-lowering effect of Arisaema Cum Bile and explore its mechanisms, providing experimental evidence for its clinical application. Biochemical analysis was used to detect serum levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), triglycerides(TG), and total cholesterol(TC) to assess the lipid-lowering activity of Arisaema Cum Bile. Additionally, 16S rDNA sequencing and metabolomics techniques were employed to jointly elucidate the lipid-lowering mechanisms of Arisaema Cum Bile. The experimental results showed that high-dose Arisaema Cum Bile(PBA-H) significantly reduced serum ALT, AST, LDL-C, TG, and TC levels(P<0.01), and significantly increased HDL-C levels(P<0.01). The effect was similar to that of fenofibrate, with no significant difference. Furthermore, Arisaema Cum Bile significantly alleviated hepatocyte ballooning and mitigated fatty degeneration in liver tissues. As indicated by 16S rDNA sequencing results, PBA-H significantly enhanced both alpha and beta diversity of the gut microbiota in the model rats, notably increasing the relative abundance of Akkermansia and Subdoligranulum species(P<0.01). Liver metabolomics analysis revealed that PBA-H primarily regulated pathways involved in arachidonic acid metabolism, vitamin B_6 metabolism, and steroid biosynthesis. In summary, Arisaema Cum Bile significantly improved abnormal blood lipid levels and liver pathology induced by a high-fat diet, regulated hepatic metabolic disorders, and improved the abundance and structural composition of gut microbiota, thereby exerting its lipid-lowering effect. The findings of this study provide experimental evidence for the clinical application of Arisaema Cum Bile and the treatment of hyperlipidemia.
Animals ; Gastrointestinal Microbiome/drug effects* ; Rats ; Male ; Metabolomics ; Hyperlipidemias/microbiology* ; Drugs, Chinese Herbal/administration & dosage* ; Rats, Sprague-Dawley ; Hypolipidemic Agents/pharmacology* ; Liver/metabolism* ; Humans ; Alanine Transaminase/metabolism* ; Triglycerides/metabolism* ; Aspartate Aminotransferases/metabolism*

Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia and dyslipidemia. Carvacrol (CAR) has demonstrated the potential to mitigate dyslipidemia. This study aims to investigate whether CAR can modulate blood glucose and lipid levels in a T2DM rat model by regulating short-chain fatty acids (SCFAs) and the GPR41/43 pathway. The T2DM rat model was induced by a high-fat diet combined with low-dose streptozocin injection and treated with oral CAR and/or mixed antibiotics. Fasting blood glucose, oral glucose tolerance, and insulin tolerance tests were assessed. Serum lipid parameters, hepatic and renal function indicators, tissue morphology, and SCFAs were measured. In vitro, high glucose (HG)-induced IEC-6 cells were treated with CAR, and optimal CAR concentration was determined. HG-induced IEC-6 cells were treated with SCFAs or/and GPR41/43 agonists. CAR significantly reduced blood lipid and glucose levels, improved tissue damage, and increased SCFA levels in feces and GPR41/43 expression in colonic tissues of T2DM rats. CAR also attenuated HG-induced apoptosis of IEC-6 cells and enhanced GPR41/43 expression.Overall, these findings suggest that CAR alleviates blood lipid and glucose abnormalities in T2DM rats by modulating SCFAs and the GPR41/43 pathway.

Objective: Cervical hybrid surgery optimizes the use of cervical disc arthroplasty (CDA) and zero-profile (ZOP) devices in anterior cervical discectomy and fusion (ACDF) but lacks uniform combination and biomechanical standards, especially in revision surgery (RS). This study aimed to investigate the biomechanical characteristics of adjacent segments of the different hybrid RS constructs in ACDF RS. Methods: An intact 3-dimensional finite element model generated a normal cervical spine (C2–T1). This model was modified to the primary C5–6 ACDF model. Three RS models were created to treat C4–5 adjacent segment degeneration through implanting cages plus plates (Cage-Cage), ZOP devices (ZOP-Cage), or Bryan discs (CDA-Cage). A 1.0-Nm moment was applied to the primary C5–6 ACDF model to generate total C2–T1 range of motions (ROMs). Subsequently, a displacement load was applied to all RS models to match the total C2–T1 ROMs of the primary ACDF model. Results: The ZOP-Cage model showed lower biomechanical responses including ROM, intradiscal pressure, maximum von Mises stress in discs, and facet joint force in adjacent segments compared to the Cage-Cage model. The CDA-Cage model exhibited the lowest biomechanical responses and ROM ratio at adjacent segments among all RS models, closely approached or lower than those in the primary ACDF model in most motion directions. Additionally, the maximum von Mises stress on the C3–4 and C6–7 discs increased in the Cage-Cage and ZOP-Cage models but decreased in the CDA-Cage model when compared to the primary ACDF model. Conclusion The CDA-Cage construct had the lowest biomechanical responses with minimal kinematic change of adjacent segments. ZOP-Cage is the next best choice, especially if CDA is not suitable. This study provides a biomechanical reference for clinical hybrid RS decision-making to reduce the risk of ASD recurrence.

Objective: Cervical hybrid surgery optimizes the use of cervical disc arthroplasty (CDA) and zero-profile (ZOP) devices in anterior cervical discectomy and fusion (ACDF) but lacks uniform combination and biomechanical standards, especially in revision surgery (RS). This study aimed to investigate the biomechanical characteristics of adjacent segments of the different hybrid RS constructs in ACDF RS. Methods: An intact 3-dimensional finite element model generated a normal cervical spine (C2–T1). This model was modified to the primary C5–6 ACDF model. Three RS models were created to treat C4–5 adjacent segment degeneration through implanting cages plus plates (Cage-Cage), ZOP devices (ZOP-Cage), or Bryan discs (CDA-Cage). A 1.0-Nm moment was applied to the primary C5–6 ACDF model to generate total C2–T1 range of motions (ROMs). Subsequently, a displacement load was applied to all RS models to match the total C2–T1 ROMs of the primary ACDF model. Results: The ZOP-Cage model showed lower biomechanical responses including ROM, intradiscal pressure, maximum von Mises stress in discs, and facet joint force in adjacent segments compared to the Cage-Cage model. The CDA-Cage model exhibited the lowest biomechanical responses and ROM ratio at adjacent segments among all RS models, closely approached or lower than those in the primary ACDF model in most motion directions. Additionally, the maximum von Mises stress on the C3–4 and C6–7 discs increased in the Cage-Cage and ZOP-Cage models but decreased in the CDA-Cage model when compared to the primary ACDF model. Conclusion The CDA-Cage construct had the lowest biomechanical responses with minimal kinematic change of adjacent segments. ZOP-Cage is the next best choice, especially if CDA is not suitable. This study provides a biomechanical reference for clinical hybrid RS decision-making to reduce the risk of ASD recurrence.

Objective:To explore the mechanism of hypertension inducing erectile dysfunction(ED)using transcriptomics and network pharmacology.Methods:We randomly divided 12 male rats with spontaneous hypertension(SHT)into an L-arginine(LA)group(n=6)and an SHT model control(MC)group(n=6),took another 6 Wistar Kyoto male rats as normal controls(NC),and treated the animals in the LA group by intraperitoneal injection of LA at 400 mg/kg and those in the latter two groups with physio-logical saline,once a day,all for 7 days.Then we observed the blood pressure and penile erection of the rats,and determined the ex-pressions of the cGMP/PKG signaling pathway-related proteins and mRNAs in different groups using ELISA,Western blot and RT-qPCR.Results:Transcriptomics combined with network pharmacology showed that the cGMP/PKG signaling pathway played a key role in hypertension-induced ED.In vivo animal experiments revealed a significantly lower frequency of penile erections in the MC than in the NC group(1.33±0.52 vs 2.67±0.51,P＜0.05).The protein expressions of eNOS,PKG and sGC were markedly de-creased in the model controls compared with those the normal controls(P＜0.05),but remarkably upregulated in the LA group com-pared with those in the MC group(P＜0.05).Conclusion:Hypertension decreases the expressions of eNOS,NO,sGC,cGMP and PKG proteins and the level of testosterone by inhibiting the cGMP/PKG signaling pathway,which consequently suppresses the relaxa-tion of the penile vascular smooth muscle and reduces erectile function.